www.healthhiv.org

HealthHIV’s

to Integrate HIV Care in Primary Care Settings

Staged Training to Engage Providers

Model

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HealthHIV developed the STEP Model for HIV integration in primary care in response to limited existing models of HIV testing and care.

The model provides a staged framework for integration of HIV care into primary care. At its core, this dynamic model classifi es community health centers and other primary care delivery sites, based upon where they fall in the spectrum of HIV care delivery.

Classifying health centers in this framework allows HealthHIV to deliver customized HIV capacity building and clinical training responsive to the needs of individual centers.

The model is derived by merging two classifi cation systems:

� Stages of HIV Care

� Models of Care

Creating the STEP Model

Stages of HIV CareThe Stages of HIV Care classifi cation system also developed by HealthHIV, aligns community health centers and other primary care sites along a spectrum according to the HIV testing,care, and treatment services delivered. Community health centers providing only testing services are classified as the Foundation Stage. Each succeeding stage represents an increase in the complexity of HIV care provided to patients.

The Stages of HIV Care were informed by the HRSA/HAB Guidelines for HIV Clinical Care as well as various State HIV care plans and the WHO clinical staging for HIV/AIDS for Adults and Adolescents.

Foundation Stage

Stage 2

Stage 1

Stage 3

Provide HIV Testing (routine or targeted) but no medical management for patients with positive test results

Onsite management of stable HIV-positive patients who are on 2nd line ARV therapy and/or those with opportunistic infections

or advanced HIV disease

Onsite management of stable HIV-positive patients who are ARV naive or on 1st line ARV therapy, and management of common complaints

Onsite management of complex HIV-positive patients who are on 3rd line or salvage therapy and/or

with complex opportunistic infections, and/or the need for PMTCT

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The Models of HIV Care classifi cation system focuses on how community health centers deliver care to patients living with HIV. Classifi cation is determined through an assessment of the systems community health center’s have in place, to meet the primary care needs of their patients living with HIV. Focusing on how HIV primary care is delivered, each model incorporates the use of onsite staff in providing HIV care, with support from more experienced on-site, or previously identifi ed community providers/mentors. Mentors or consultants are used to facilitate the delivery of most of the HIV care by the community health center’s staff providers/clinicians, with availability for consultation as needed for cases of higher medical complexity or acuity.

The Models of HIV Care were informed by the National Association of Community Health Centers’ resource “Integrating HIV Screening into Routine Primary and Dental Care: A Health Center Model” and the CDC’s Program Collaboration and Service Integration Framework. In addition, HealthHIV conducted qualitative interviews with CHCs to determine which models developed organically within CHCs.

Models of HIV Care

External HIV Care

Supported HIV Care

Collaborative HIV Care

Comprehensive HIV Care Management

HIV testing (routine or targeted), but no medical management for HIV Patients.

HIV care within primary care supported by consultationwith clinical mentor as needed.

HIV care with primary care with extensive collaborationand consultation from clinical mentor.

HIV and primary care fully integrated for management of complex co-morbid conditions, PMTCT, and complex OIs.

Access consultation from clinical experts as needed.

HealthHIV’sThe STEP (Staged Training to Engage Providers) Model is a framework for integrating HIV care into primary care, recognizing that community health centers are each at different stages in their HIV care provision. The model is used to classify community health centers along a spectrum of HIV care delivery, provide a framework for the delivery of capacity building assistance, and guide a stepwise progression for health centers implementing higher level of care and management for patients living with HIV.

The model guides capacity building and clinical training to advance community health centers toward the goal of providing comprehensive primary care for their patients living with HIV.

HealthHIV’s HIV Primary Care Training and Certifi cate Program is based upon HealthHIV’s STEP model for integrating HIV in Primary Care. The program is designed to improve clinical and professional knowledge, skills, and competencies as well as improve ability to provide quality care to people living with HIV.

This program is designed for primary care providers (MDs, or DOs, nurse practitioners, and physician assistants) who are responsible for caring for patients at-risk for or infected with HIV. For details of HealthHIV’s HIV Primary Care Training and Certifi cate Program, visit www.healthiv.org

HealthHIV’s STEP (Staged Training to Engage Providers) Model

The Model in Action: The HIV Primary Care Training and Certifi cate Program

External HIV Care

SupportedHIV Care

CollaborativeHIV Care

ComprehensiveHIV Care

Management

Provide HIV testing (routine or targeted)

but no medical management for

patients with positive results

Onsite HIV care integrated with primary care, supported by

consultation with clinical mentor as

needed for management of treatment failure

and/or co-morbid conditions compli-

cated bt HIV disease and/or trearment

Onsite HIV care integrated with

primary care through extensive consultation

from clinical mentor for initiation of ARV regimen and

for management of more complex

patients

Onsite HIV care integrated with primary care,

including management of

complex co-morbid conditions, PMTCT, and complex OI’s

with access to consultation from clinical mentors as

needed

Foundation

Stage 2

Stage 1

Stage 3

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